Ob-gyns take their training to a global stage

In 2010, ACOG Fellow Annekathryn Goodman, MD, found herself in a makeshift hospital in Haiti: 14 Army cots, two tents (one that doubled as an operating room), thousands of refugees from the magnitude-7.0 earthquake, and lots and lots of pregnant women.

“No matter what’s going on in the world, women are having babies, and often in environments that put their lives at risk,” said Dr. Goodman, a gynecologic oncologist at Massachusetts General Hospital in Boston. “We saw women with normal pregnancies and labors, but also women with broken backs and pregnant, or paraplegic and pregnant.”

Because Dr. Goodman possessed the best surgical skills on her team, she became the default obstetrician. That suited her just fine. An ob-gyn since 1990, she’d been using her medical training to help women for decades.

Like Dr. Goodman, many ob-gyns use their training to help women worldwide. Whether it’s through mission groups, human rights campaigns, or training programs, ACOG Fellows have worked and shared their expertise to improve maternal health on a global scale.

There’s good evidence that the impulse to serve maternal health needs around the globe is widespread among doctors, said Taraneh Shirazian, MD, director of global health in the department of obstetrics, gynecology, and reproductive sciences at the Icahn School of Medicine at Mount Sinai Medical Center in New York City. Dr. Shirazian teaches a global women’s health course for ob-gyn residents in New York City and is the editor of the forthcoming Around the Globe for Women’s Health: A Practical Guide for the Health Care Provider. Research shows that about half of all graduating medical students are interested in doing global health work, she said.

“But they aren’t the only group. There are many committed and passionate physicians who have a commitment to work abroad and do work that gives back globally,” Dr. Shirazian said.

And that’s a good thing because the need for improved global maternal health care is dramatic. Every year, almost 300,000 women die during pregnancies and childbirth, and many more are permanently disabled, according to the Bill and Melinda Gates Foundation. Most of those deaths occur in the developing world.

Dr. Thomas Gellhaus with a nurse in Bolivia on one of his many medical mission trips.

Providing care where there is none

Thomas M. Gellhaus, MD, of Iowa City, IA, is one of those ob-gyns who wanted to do global health work during his residency in the late 1980s. But getting there wasn’t so easy.

“You go to medical school and then residency and then you get married and have kids,” he said. “There wasn’t time to do anything else.”

So when the opportunity to travel overseas presented itself in 1996 through Medical Ministry International (MMI), he took it. And, he said, “it changed our lives.” ACOG recognized Dr. Gellhaus for his global work with the Award for International Service in 2011.

Since 1996, Dr. Gellhaus and his wife, Melanie, (and many times, their children) have traveled to the Dominican Republic, Ecuador, Peru, Bolivia, and Tanzania—about 17 trips total—performing procedures that are routine in the US but hard to come by in those countries. With MMI, doctors like Dr. Gellhaus bring almost everything they need, from sterile gauze to anesthesia, to college students to do crowd control for the hundreds of people who show up.

Seeing 200 people lined up for your care makes up for the long hours, simple food, and the sometimes intense poverty, he said. The advantage of such trips is direct contact with a patient, said Thomas F. Arnold, MD, an ob-gyn in Dickinson, ND, and chair of ACOG’s District VI.

“In international work, you can take the same resources, energy, time, and monetary contributions and affect 1,000% more than what you could in the US,” said Dr. Arnold, who has done trips with MMI as well.

The drawback is that when Drs. Arnold or Gellhaus leave, often they take with them most of the ob-gyn care in the area. But that’s not always the case. Dr. Gellhaus recalls some local doctors scrubbing in with him, videotaping his procedures for study later. And many days begin with lectures. Dr. Arnold remembers a urologist in Bolivia who watched with careful attention as Dr. Arnold and his team performed a minimally invasive procedure for stress urinary incontinence and pelvic floor relaxation.

The Bolivian urologist salvaged the disposable equipment after the case so he could attempt to duplicate the system with locally available resources after Dr. Arnold’s team had gone. “Even though what we’re doing seems very small when you’re looking at a whole region or country, every journey starts with a single step,” Dr. Arnold said.

Dr. Annekathryn Goodman, on the right, helps deliver a baby in a tent in Haiti after the January 2010 earthquake.

Building a system to stop cervical cancer deaths

In 2012, ACOG honored Dr. Goodman with the Award for International Service. Dr. Goodman may have started her global health work in disaster relief, but today her passion lies in Bangladesh. It is there that more than 10,000 women die every year from cervical cancer—the fourth highest rate in the world, according to a report from the Cervical Cancer Free Coalition. To Dr. Goodman, that’s staggering.

“If you don’t die of childbirth in Bangladesh, you die of cervical cancer,” she said. “There’s no cervical cancer screening, and the majority of the women there have never been screened.”

So in 2008, after attending an international conference on maternal health with a Bangladeshi colleague, she set out to create a screening program in one of the larger slums. Almost immediately, she hit upon a challenge: Once a woman is diagnosed, then what?

“Once you develop the screening, you have to build treatment,” she said. So she did. Because most women are diagnosed with advanced cervical cancer, most physicians have little experience treating it. Dr. Goodman is working to build a network of local physicians who want to learn and travels to Bangladesh three to four times a year with residents and fellows to teach the treatment.

Together, they are building an infrastructure so that once a woman is diagnosed, there’s somewhere she can go, someone who can treat her, and she doesn’t have to lose her life.

“Bangladesh is such a fascinating, vibrant society,” she said. “When I’m not at Mass General, I’m working on developing cancer care treatment for women and resources for the physicians in that area. Life is really full of wonderful opportunities to get involved.”

Women’s health care as a pathway to human rights

Michele G. Curtis, MD, MPH, MML, is proof that you don’t need to leave the US to do global health work. Dr. Curtis, of Humble, TX, started by providing pro bono exams for women through the nonprofits Tahirih Justice Center, Amnesty International, and Physicians for Human Rights. Sometimes the exams were for women seeking asylum from countries practicing female genital mutilation. Other times, they were exams of female victims of sexual torture or human trafficking. The work brought together Dr. Curtis’s clinical expertise with her master’s in public health and law degree.

In the last several years, Dr. Curtis joined Physicians for Human Rights in its campaign to teach better sexual assault treatment in Africa. As part of a team, Dr. Curtis has been working with physicians, police officers, and judicial officials in Kenya to identify and properly report sexual violence. “Can anyone save the world? No. But can each of us clean up our own little corner of the world? Yes,” Dr. Curtis said.